How do you choose your first job?

[shinyhappy1, BSN]

I've just graduated with my BSN, and have been lucky to have gotten some job offers. My goal has been ICU or L&D, as I know other nurses that started in those specialties, or to start in med/ surg, if I have to. Eventually, I'd like to do travel nursing.

Unfortunately or fortunately (I'm not sure), my local area doesn't seem to have any med/ surg jobs available for new grads. In fact, starting in an acute setting seems pretty much off limits. Unless someone is offering relocation assistance for new nurses, I am not in a position to be able to move.

I've been offered jobs in home health, LTC, psych, and pain management. I sincerely want to be able to do well in whichever I choose and serve the patients to the best of my abilities. I also want to take whatever I can from these opportunities so that I can grow as a nurse. But I am also afraid of being pigeonholed into a specialty that I don't like and can't get away from later or hurting my long term income potential.

I've tried to do research on my own to help me choose, but my research has not returned with information that will help me choose. How do you choose your first job?

If possible, please vote on which area I should start with with these criteria in mind in this order:

1. Offers skills that will make me a desirable hire to future jobs

2. Ability to move away from the field, if I dislike it

3. Ability to do travel nursing in the specialty

4. Pay will go up as I develop my skills

[IntensiveCCRN]

Have you looked into Nurse Residency programs? That is how people usually get their foot in the door with bedside nursing as a new grad.

Critical Care Nursing | Intensive RN

[shinyhappy1, BSN]

I have applied for both of them in this area. I know 2 people from my class that were hired, but both have local connections to the hospital. I do not have many local connections because I moved here from California for school.

A big part of the issue is that there are 7 nursing programs in this area, 3 of which are private so those put out a group of about 30 nurses each every 2-4 months, in addition to the other groups, which graduate twice a year. The city is big enough, but the never ending stream of nurses means that the hospitals can be very picky and nepotism is definitely part of the culture, as it is in most places. I'm not complaining. I'm just saying that is the situation.

Additionally, the next town is about 1 1/2 hours away (which has about 5,000 people). After that, the next decent sized city is about a 4 hour drive. The end result is that I have to work within the city, since there is nowhere reasonable to commute to.

In this area, even the new grad programs (of which there are only 2) hire nurses with some experience, but not more than a year. That is a possibility, but in no way a guarantee that I'll be chosen if I apply for the only other round I'm eligible for in 6 months.

I don't mind not working at a hospital. That was my original goal, but situations change and I feel blessed or lucky to have the luxury to choose at all, with no experience. I just want to figure out which path I should pursue, if hospital nursing proves elusive. Honestly, I just want the opportunity to become a knowledgeable, well-rounded nurse, which I think I can become outside of the hospital environment. Patients need care in many environments, so that aspect doesn't bother me. But, I don't want my decisions now to shoot me in the foot later.

[Crush]

Have you considered part time work in 2 different areas to diversify and make yourself more marketable later? Maybe LTC and something else for a year before moving on type thing?

[shinyhappy1, BSN]

Thank you for that suggestion, Crush. I actually have considered that.

I've seriously considered working psych and home health at the same time, because I think those would both prove to be useful for gaining a varied base of knowledge. I can't work psych and LTC at the same time, because the schedules don't allow that. I could do LTC and HH, but I think many of the things that I would learn would overlap, so that doesn't seem necessay. If I did pain management, that would have to be the only job, because it is 5 8's.

[Sour Lemon]

Out of those choices, I'd choose long term care for the most versatility. I like psych, but I wouldn't recommend it as a starting point unless you have a desire to stay there. Home health would be scary with no experience unless you only got the simplest cases. Pain management doesn't seem like it would prepare you much for anything else.

So while it can be difficult to get hired on at a hospital with only nursing home experience, I think it's more likely than lone experience in the other areas.

[Crush]

I agree with SourLemon. If you can't do 2 different then I would go with LTC. You can still transition into acute care later with the experiences you'll get there. Or transition to whatever area you choose. Who know, maybe you'll like it and decide that is your niche?

[shinyhappy1, BSN]

Thank you for your advice!

Do you recommend staying away from HH only because of the responsibility or do you also feel that my learning would be limited?

Concerning psych, I'm not opposed to staying in it. I honestly don't know. I really like the idea of being able to help and advocate for such an underserved population, but I can't tell from my clinical experience whether I would enjoy doing that work long term. It is a difficult population with some very specific needs. I only hope that I have the emotional reserve for it in the long term.